Combating a Crisis

Opioid abuse and opioid-related deaths are a growing public health problem in communities across the United States – and with many primary care providers reporting being inadequately prepared to identify and assist patients with substance use disorders, it is vital to arm current and future health professionals with the appropriate resources and methods to combat this crisis.

Yu-Ping Chang, PhD, RN, FGSA, interim associate dean for research and scholarship and a mental health and addictions researcher, is doing just that. She found that motivational interviewing (MI), a form of behavioral intervention, is an effective tool to curb abuse. Her study on the effects of MI on prescription opioid adherence demonstrated positive effects in a primary care office-based setting.

MI, a brief intervention that capitalizes on an individual’s motivation to change problematic behavior, was found to enhance prescription opioid adherence among older adults with chronic nonmalignant pain who are at risk for misuse. This provides important information to health care providers about the feasibility of implementing such an intervention in outpatient settings where at-risk patients are increasingly seeking help for substance use issues.

While prescription opioid analgesics are commonly prescribed pain medications, the transition from prescription opioid use to opioid abuse leading to heroin abuse has not been studied thoroughly. Evidence suggests that market forces, including accessibility and cost, are driving the transition from prescription opioids to increased heroin use.

Policies enacted by the FDA to deter opioid misuse and abuse may play a role in the recent call to action stressing the importance of preparing primary care providers with the tools they need to recognize prescription drug misuse and abuse before individuals turn to illicit drugs as an alternative. According to the FDA, such policies include public educational efforts, prescription drug monitoring programs, increased enforcement efforts to address doctor shopping and pill mills, regulatory actions such as diverting individuals with substance use disorders to drug courts with mandated engagement in treatment, and abuse-deterrent formulations.

Armed with this knowledge, the UB School of Nursing has joined other American Association of Colleges of Nursing members in pledging its commitment to the White House National Opioid Education Campaign. The aim is to educate advanced practice registered nursing students on the guidelines for prescribing opioids for chronic pain by implementing a plan to introduce educational materials incorporating MI into the family nurse practitioner (FNP) curriculum – a valuable marriage of evidence-based research with clinical practice.

Educational materials are now incorporated into courses throughout the FNP curriculum. Lectures include instruction on how to screen and assess patients for risk of opioid misuse, as well as training on initiating a dialogue with those who misuse or abuse opioids.

Chang observes that for students, it may be challenging to start a dialogue with those in need of behavioral intervention – but that dialogue is necessary to augment the patient’s motivation to change problematic behavior, and to encourage adherence to their medication regimen.

While offering support and encouragement to patients may be more intuitive, practitioners must be equipped with an arsenal of skills that enable them to establish a trusted and therapeutic relationship that promotes self-efficacy. Students learn skills such as reflective listening, affirmation techniques and open-ended questioning to encourage candid conversation. They also practice communication methods to summarize sessions, which reinforces discussion and builds motivation to substitute harmful behaviors with healthy behaviors. Student knowledge is evaluated through simulation of interviewing techniques.

Chang recently received a grant from the Health Foundation for Western and Central New York to develop course materials that will enhance nursing students’ competency in caring for older adults with mental health and substance abuse issues. According to Chang, “MI is an essential skill for all practitioners. We must prepare our students with the knowledge needed to screen, assess and intervene for those individuals deemed at risk for opioid abuse. Behavioral intervention in a primary care setting is the key to success, and patient education is critical to adherence.”

-DONNA A. TYRPAK